HB 133.2 

■SsBa 



HB 1323 

.S5 B2 

Copy 1 A REPORT 



DEATH-RATE OF EACH SEX IN MICHIGAN, 



COMPARISON WITH DR. FARR'S LIFE TABLES OF 
HEALTHY DISTRICTS OF ENGLAND. 



WITH A STATEMENT CONCERNING 



INFANT MORTALITY IN MICHIGAN. 



BY 

HENRY B. BAKER, M. D., 

Secretary of the State Board of Health, Xnd Registrar of Vital Statistics in Michigan. 



\Reprinted from Vol. IJ. Public Health Papers of the American 
> Public Health Association^ 



1876. ;/) 



CAMBRIDGE: 

^rintcD at tfjc 0i\jcr^idc ^u$$. 

1876. 



s 




A REPORT ON THE DEATH-RATE OF EACH SEX IN MICH- 
IGAN, AND A COMPARISON WITH DR. FARR'S LIFE TABLES 
OF HEALTHY DISTRICTS OF ENGLAND. 

By henry B. baker, M. D., 

Secretary of the State Board of Health, and Registrar of Vital Statistics of Michigan. 

KEAD AT THE ANNUAL MEETING IN PHILADELPHIA, NOVEMDER 10, 1S74. 

In Stating and comparing the total death-rate in Michigan, I do so by 
means of Life Tables, for the reason that I know of no other method 
whereby it can be properly stated or compared. VVe may say that the 
annual mortality is such a specified per cent, of the living inhabitants; but 
the population of our cities and States is far from a fixed one, and varies in 
each city. State, or country, and the death-rate depends so much upon the 
age and sex of the inhabitants that no very useful estimate of the healthful- 
ness or unhealthfulness of a climate or locality can be formed from such 
imperfect data. It is requisite, first, to construct a Life Table, or to reduce 
the statement to one concerning a "fixed population," — that is, a popula- 
tion such as would be maintained in that locality by a specified, constant, 
and uniform birth-rate alone, without immigration or emigration. 

Life Tables for the entire United States, constructed from the United States 
censuses, are almost necessarily to some extent " evolved from the inner 
consciousness " of those who construct them. This is so for the reason that 
it has not been possible to obtain reliable data which would enable one to 
make the necessary corrections for the omission of deaths in the enumera- 
tion. That this may not stand simply as an unsupported assertion, I wish 
to cite a few of the recognized authorities. Referring to this subject, the 
author of the Life Table in the United States Census volume for i860 re- 
marks : "Hence to know the true law of mortality, we must either await 
such progressive registration, or else resort to new methods of analysis and 
combination of the existing statistics, as here proposed." For the Life 
Table published in that volume the death-rate appears to have been estab- 
lished by first increasing the deaths returned by a constant factor, derived 
from the mind of the statistician, then separately modifying the death-rate of 
those aged under five years, of those aged 70 to 80 years, and of those aged 
80 to 90 years, each by a different factor arrived at by estimates, appar- 
ently based upon the author's general knowledge of vital statistics. 

For the Life Table published with the census of 1870, Mr. Elliott in- 
creased the deaths returned by 41 per cent., this being requisite to make the 
death-rate equal that in England and Wales. It may be objected that when 
this is done we do not learn anything concerning the real death-rate in the 
United States, for we have forced it to appear the same as already found to 



2 REPORT ON THE DEATH-RATE 

be in some other country. Life Tables thus constructed must necessarily 
be very much like Life Tables in England and Wales. On this point Mr, 
Elliott remarks ^ that " It is impossible to determine with precision the 
amount of deficiency in the return of deaths, but from the results herein 
computed on the assumption of a deficiency of forty-one per cent., it is easy 
to calculate corresponding values which shall conform to the assumption of 
any other supposed rate of deficiency." 

In the Insurance Report of Massachusetts for the year 1868, page 103, 
Mr. L. W. Meach published a Life Table for males in the United States, 
" upon the ample basis of thirty years' observations," which probably means 
that it was formed from the three United States Censuses of 1840, 1850, 
and i860; but upon what plan the omissions in returns of deaths were 
estimated is not stated. Other Life Tables may have been published, but 
all that have come to the writer's notice have been mainly estimates, in the 
absence of exact evidence on the subject. General Walker, Superintendent 
of the Ninth United States Census, remarks that " The dimensions attained 
by the life insurance interest within the past few years make it peculiarly a 
matter of regret at the present time that the census should not afford the 
data for determining with absolute precision and certainty the death-rate of 
the country, whether in the aggregate, or by classes of the population." ^ 

Inasmuch as no method has yet been found, or at least acted upon, 
whereby the actual death-rate can be positively ascertained for the United 
States, or, so far as I know, for any single State, I venture to offer these 
Life Tables for males and for females in Michigan, as tables based entirely 
upon evidence of the death-rate in the State, the corrections for omissions 
in enumerating being made upon a principle which does not appear to have 
been tried in any other locality. The principle upon which the correction 
is made may be stated briefly as follows : The number actually omitted be- 
cause of a delay of a given time, as for instance of one year, is ascertained 
by comparing the results of two separate enumerations of the deaths in the 
same locality during the same time, one enumeration being made at one 
time by one set of officers, the other at a different time by a different set of 
officers. We thus find the proportion of deaths omitted after the lapse of 
a given time. It is assumed that the proportional number omitted is in 
proportion to the length of time which has passed since they occurred, and 
before their enumeration. 

It is not possible to say that even if enumerated in the same months in 
which the deaths occurred none would be forgotten or overlooked ; but for 
this, no correction has been proposed, and none is here offered. It is not 
probable that many would be omitted under such circumstances. 

It is quite probable that some other modification may hereafter be discov- 
ered to be essential to perfect accuracy, but the writer believes that this 
method will be found to be adequate to the correction of at least the greater 
part of the error in the returns of deaths made after the close of the year in 
which the deaths occurred, as is the case at present in Michigan and in the 
enumeration for the United States Census. 

1 Page 10, Vital Stat. U. S. Census, 1S70. 

2 Foot-note on page 9, Vital Stat. U. S. Census, 1S70. 



OF EACH SEX IN MICHIGAN. 3 

The results of this method of correction, which apj^ear in this table for 
males and females, are based simply upon the evidence collected in one 
State, and in one year, — that of 1870. In order to render the evidence more 
reliable, observations must be extended through a long series of years. The 
death-rate in Michigan, so far as evidenced by the returns, was larger during 
the year 1870 than it usually is, the increased number of deaths being re- 
turned as caused by zymotic diseases. There were no very serious epidem- 
ics of small-pox, cholera, or other contagious diseases, except scarlatina, from 
which 852 deaths were returned. These tables do not therefore include 
those chances of death attendant upon serious epidemics. 

The correction for omissions was made by comparing the returns for the 
census year as made by the registration officers with those of the census 
marshals, thus : 

Deaths by Census. Deaths by Registration. 

Dec. i86g. Jan. 1870. Dec. iS6g. Jan. 1S70. 

801 : 800 : : 836 : X , whence X = 834. The number act- 
ually returned for January, 1870, by the registration officers was 421; 834 
— 42i=:4i3^98.o9 per cent, of the numbers returned. The deaths for De- 
cember and January were enumerated by the census marshals about five 
months after they occurred ; the deaths for December were enumerated by 
the registration ofiicers after about four months, but the deaths for January 
were not enumerated by the registration officers until after a year and four 
months. This 98.09 per cent, was therefore added to the deaths for Jan- 
uary, 1870, as a correction for omissions because of one year's additional time 
elapsing between the occurrence of the deaths and their enumeration. Upon 
evidence which seemed to warrant the assumption, it was assumed that if 
the lapse of one year's time resulted in omissions to such an extent that 
98.09 per cent, of the deaths returned should be added to them to make 
them equal the deaths which would have been returned if enumerated in 
months of occurrence, then the lapse of one month's time would require the 
addition of one twelfth of that per cent, and the intermediate months in a 
corresponding proportion. 

The methods and results of the corrections will be best explained by 
means of exhibits A and B, and diagrams 3 and 4, graphically representing 
the same. 



REPORT ON THE DEATH-RATE 



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DIAGHxUI X?3. 



Dsai; i^l!i:M§aii durmg year endii^ Jtjuc 11370 a; rs^amed, 's 

cciTsrwed for Cteky of oneyear, corrected as if emimerxLsd in months "" 

cccurrsnce sjasJiiied to tmifcrir: p op-jlation, as corrected aad egua.- 

hzQi to Timfom poptilitios.- md tc months of ^zmfbnn length. 




TOt CALVERT urn. CO. DETRO 



Dedcuei ly KB.BakerJlH 



OF EACH SEX IN MICHIGAN. 




6 REPORT ON THE DEATH-RATE 

The omissions during the year ending Jime i, 1870, appeared to be such 
that the deaths returned should be multiplied by 1.86 in order to equal the 
number which was believed to have occurred, but the deaths returned for 
the year ending December 31, 1870, corrected upon the same principle, it 
appears should only be multiplied by 1.79 in order to equal the true num- 
ber. As the system of registration becomes more perfect, it is probable 
that the amount of the correction may be modified, and a mean of several 
years would approximate closer to the true statement. These life tables are 
made by using the decimal 1.86 with which to multiply the deaths returned, 
that being the first result of a direct comparison and correction in this man- 
ner. It is possible that it may increase the number of deaths slightly more 
than should be done. For the year for which the tables are made, deaths 
were also returned in greater number than for the year preceding or suc- 
ceeding. On the other hand, no very extraordinary epidemic prevailed. 
The correction is only claimed to make the deaths equal the number which 
would have been returned if enumerated in the months when they occurred. 

In constructing these life tables for Michigan, the population represented 
by deaths was equalized throughout all ages before computing the death- 
rate, which was computed for each and every age, in order that if any real 
" climacteria " exist they might be discovered. Climacteria cannot well be 
discovered when the death-rate is computed by periods often years. If the 
death-rate is computed by periods of five years, every alternate period will 
contain the important even year — such as twenty, thirty, forty, fifty, etc. — 
and the death-rate for that period will appear too small, because the number 
of inhabitants stated in the census as living at such ages is always too large. 
The statement of the age of persons who have died is much more accurate 
than the statement of the age of the living. By equalizing the population 
before computing the death-rate, we may avoid equalizing the deaths, and 
leave them free to exhibit at each and every age any variation which may 
occur. 

It may be proper in this connection to call attention to the fact that the 
life table for females in Michigan, does not show any extraordinary increase 
of the death-rate of women aged forty to fifty years as compared with the 
males of the same ages ; on the contrary for about all ages over that of fifty 
years, the death-rate of males exceeds that of females. It increases some- 
what rapidly, however, for both sexes, at about that age. 

The essential columns of these life tables are here presented. 



OF EACH SEX IN MICHIGAN. 



Table i. — Exhibiting the essential parts of Life Tables for each sex in Michi- 
gan, stating, for each age, the Chances of Death for one thousand persons 
living at that age, the Average Future Duration of Life, the Probable 
Fiitm-e Duration of Life, and the Probable Age at Death. 



Age in 


Deaths to 


one thou- 


Mean after Lifetime 


True Expectation of 






Years. 


sand 


iving. 


at each Age.i 


Life (Probable Life). 


Probable A 


ge at Death. 




Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 





1 69. 1 


1350 


43-79 


44.24 


53-05 


49-52 


53.05 


49.52 


I 


56.2 


47.8 


51.61 


50-07 


60.48 


58.14 


6L48 


59.14 


2 


29.8 


254 


53-65 


51-56 


61.23 


59-93 


63.23 


61.93 


3 


22.7 


18.8 


54-28 


51.89 


61.24 


59-91 


64.24 


62.91 


4 


14.0 


13-5 


54-53 


51-87 


60.91 


59-58 


64.91 


63.58 


5 


II.7 


ii.S 


54-30 


51-58 


60.24 


59-03 


65.24 


64.03 


6 


S-5 


10.7 


53-94 


51.19 


59-48 


58.30 


65.48 


64.30 


7 


5-9 


7-4 


53-39 


50-73 


58.66 


57-56 


65.66 


64.56 


8 


6.7 


6.6 


52-71 


50.11 


57-78 


56-73 


65.78 


64.73 


9 


^1 


6.6 


52.06 


49-44 


56.92 


55.88 


65.92 


64.88 


lO 


5-6. 


4-5 


51-34 


48.76 


56.04 


55-31 


66.04 


65.31 


II 


4.0 


4.8 


50-63 


47-98 


55-18 


54-17 


66.18 


65.17 


12 


5-2 


5-3 


49-S3 


47-21 


54-29 


53-31 


66.29 


65.31 


13 


4.0 


6-3 


49.09 


46.46 


53-42 


52.46 


66.42 


65.46 


14 


4.1 


5-6 


48.28 


45-75 


52-52 


51-65 


66.52 


65.65 


15 


3-9 


8.8 


47.48 


45.01 


51-63 


50.81 


66.63 


65.81 


i6 


4.2 


7-5 


46.66 


44-40 


50-73 


50.06 


66.73 


66.06 


17 


5-7 


9.4 


45-86 


43-73 


49-83 


49.29 


66.83 


66.29 


i8 


4-7 


8.7 


45.12 


43-14 


48.98 


48.58 


66.98 


66.58 


19 


8.8 


11.7 


44-33 


42.52 


48.10 


47-84 


67.10 


66.84 


20 


6.9 


8.8 


43-72 


42.02 


47-32 


47.16 


67.32 


67.16 


21 


10.5 


8.4 


43-02 


41.38 


46-49 


46.38 


67.49 


67.38 


22 


7-3 


12.7 


42.47 


40.73 


45-75 


45-58 


67.75 


67.58 


23 


7.8 


8.1 


41.78 


40.25 


44-93 


44-89 


67.93 


67.89 


24 


6.6 


II. 2 


41.10 


39-57 


44.20 


44.08 


68.20 


68.08 


25 


6.1 


9-3 


40-37 


39.02 


43-46 


43-32 


68.46 


68.32 


26 


69 


10.8 


39.62 


38-38 


42.70 


42.52 


68.70 


68.52 


27 


6.4 


II. I 


38.89 


37-79 


41.97 


41-75 


68.97 


68.75 


28 


6.7 


'o-5 


38.14 


37-21 


41.14 


40.98 


69.14 


68.98 


29 


6-3 


8.9 


37-39 


36.67 


40.30 


40.29 


69.30 


69.29 


30 


5-9 


II.4 


36.62 


36.00 


39-45 


39-51 


69.45 


69.51 


31 


%-^ 


9.4 


35-S4 


35-41 


38-59 


38.78 


69.59 


69.78 


32 


8.9 


IS.3 


35-06 


34-74 


37-73 


38.00 


69.73 


70.00 


33 


7-1 


8.4 


34-37 


34-38 


36-94 


37-34 


69.94 


70.34 


34 


6.2 


II. 6 


33-61 


33-66 


36.07 


36-50 


70.07 


70.50 


^1 


8.2 


15.8 


32.82 


33-05 


35-15 


35-70 


70.15 


70.70 


36 


6.1 


9.1 


32-09 


32-58 


34-27 


34-99 


70.27 


70.99 


21 


6.3 


1 1.4 


31.28 


Z^-'^l 


33-36 


34.16 


70.36 


71.16 


3S 


10. 


13.6 


30.48 


31-23 


32.45 


33-38 


70.45 


71.38 


39 


6.3 


10.5 


29.78 


30.66 


31-59 


32-64 


70.59 


71.64 


40 


9.2 


8.2 


28.96 


29.98 


30-67 


31-S3 


70.67 


71.83 


41 


6.4 


8.1 


28.23 


29.22 


29.80 


30-99 


70.80 


71.99 


42 


9-3 


13-7 


27.41 


2S.46 


2S.89 


30.12 


70.89 


72.12 


43 


10.8 


11.4 


26.66 


27.84 


28.01 


29.35 


71.01 


72.35 


44 


"•5 


10.4 


25-95 


27.16 


27.18 


28.53 


71.18 


72.53 


^^ 


II. 


II. 2 


25-24 


26.44 


26.36 


27.70 


71.36 


72.70 


46 


II.O 


6-3 


24.52 


25-73 


25-53 


26.88 


71.53 


72.88 


47 


S-5 


II. 5 


23-78 


24.89 


24.70 


25.98 


71.70 


72.98 


48 


10.3 


14.7 


22.98 


24.18 


23.82 


25-15 


71.82 


73.15 


49 


12.6 


II. 5 




23-53 


22.98 


24.36 


71.98 


73.36 


50 


17-5 


16.6 


21.50 


22.80 


22.13 


23-53 


72.13 


73.53 


51 


12.4 


9.1 


20.87 


22.17 


21-33 


22.76 


72.33 


73.76 


52 


18.S 


14-5 


20.12 


21-37 


20.47 


21.89 


72.47 


73.89 


53 


15-3 


14.8 


19.49 


20.68 


19.68 


21.08 


72.68 


74,08 



1 Average Future Duration of Life, so-called " Expectation of Life." 



RErORT ON THE DEATH-RATE 
Table i. — Life Table fo7- Michigcvi, Co?itinned. 



Age in 
Years. 


Deaths to 
sand : 


one thou- 

iving. 


Mean after Lifetime 
at each Age.i 


True Expectation of 
Life (Probable Life). 


Probable A 


;e at Death. 




Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


54 


17.8 


13.2 


18.79 


19.98 


18.85 


20.26 


72.85 


74.26 


55 


22.1 


17.2 


18.12 


19.24 


18.06 


19.42 


73.06 


74.42 


56 


19.5 


20.5 


17-52 


18.57 


17-37 


18.62 


73.37 


74.62 


57 


29.2 


18.0 


16.86 


17-95 


16.64 


17.85 


73.64 


74.85 


5S 


25.0 


12.3 


16.35 


17.27 


16.04 


17.07 


74.04 


75.07 


59 


19.2 


15.0 


15.76 


16.48 


15-39 


16.22 


74.39 


75.22 


60 


24.2 


20.1 


15.06 


15-72 


14.65 


15.41 


74.65 


75.41 


61 


24-3 


16.7 


14.42 


15.04 


13-97 


14.67 


74.97 


75.67 


62 


37-9 


26.6 


13-76 


14.28 


13.28 


13-87 


75.28 


75.87 


63 


28.3 


28.4 


13.29 


13.66 


12.74 


13-15 


75.74 


76.15 


64 


33-3 


42-5 


1266 


13.04 


12.07 


12.42 


76.07 


76.43 


65 


47 -o 


34-0 


1208 


12.60 


11-39 


11.80 


76.39 


76.80 


66 


38.3 


32-7 


11.65 


12.03 


10.84 


11.12 


76.84 


77.12 


67 


39-6 


40.1 


11.09 


11.42 


10.18 


10.46 


77.18 


77.46 


68 


24.9 


45-9 


10.53 


10.87 


9-51 


9.86 


77.51 


77.86 


69 


41.7 


40.6 


9-79 


10.37 


8.71 


9.26 


77.71 


78.26 


70 


69-3 


S4-0 


9.19 


9-79 


8.04 


8-59 


78.04 


78.59 


71 


63.8 


51-7 


8.84 


9-32 


7.70 


8.00 


78.70 


79.00 


72 


85-3 


60.3 


8.41 


8.80 


7-25 


7-44 


79.25 


79.44 


IZ 


70.1 


67.9 


8.15 


8-33 


6.92 


6.92 


79.92 


79.92 


74 


71.8 


82.3 


7.72 


7-90 


6.48 


6.47 


80.48 


80.47 


75 


79-7 


77-5 


7.28 


7-57 


6.02 


6.11 


81.02 


81.11 


76 


lOI.O 


105.1 


6.87 


7.16 


5-63 


5-71 


81.63 


81.71 


77 


117.4 


96.0 


6.58 


6.94 


5-36 


5-51 


82.36 


82.51 


78 


105.3 


120.7 


6.40 


6.63 


5.16 


5.20 


83.16 


83.20 


79 


122.6 


1 18.3 


6.09 


6.47 


4.S7 


5.06 


83.87 


84.06 


80 


126.0 


1 23. 1 


5-87 


6.27 


4.66 


4.89 


84.66 


84.89 


81 


129.4 


127.9 


5-65 


6.08 


4-44 


4.72 


85.44 


85.72 


82 


142.8 


132-7 


5-41 


5.89 


4-23 


4-57 


86.23 


86.57 


83 


145.2 


137-5 


5-23 


5-72 


4-09 


4.42 


87.09 


87.43 


84 


157-0 


142.3 


5-04 


5-55 


3-93 


4.26 


87.93 


88.26 


85 


159-1 


147.1 


4.88 


5-39 


3.80 


4-13 


88.80 


89.13 


86 


161. 2 


151-9 


4.71 


5-24 


3-64 


4.00 


89.64 


90.00 


87 


171. 


156-7 


4.52 


5.09 


3-46 


3-89 


90.46 


90.87 


88 


180.8 


161. 5 


4-35 


4-94 


3-30 


yn 


91.30 


91.77 


89 


190.6 


166.3 


4.21 


4-79 


3.16 


3-65 


92.16 


92.65 


90 


197.1 


171. 6 


4.08 


4-65 


3-05 


3-54 


93.05 


93.54 


91 


203-5 


177-5 


3-96 


4-51 


2-95 


3-42 


93.95 


94.42 


92 


210.0 


183.4 


3-85 


4-37 


2.86 


3-31 


94.86 


95.31 


93 


216.S 


189.3 


3-74 


4.24 


2.78 


3.20 


95.78 


96.20 


94 


223.0 


195-2 


3-63 


4.12 


2.70 


3-09 


96.70 


97.09 


% 


229.5 


201. 1 


3-53 


3-99 


2.63 


2-99 


97.63 


97.99 


96 


235-9 


207.0 


3-43 


3-87 


2-55 


2.91 


98.65 , 


98.91 


97 


242.4 


212.9 


3-34 


3-75 


2.48 


2.84 


99.48 


99.84 


98 


248.9 


218.8 


3-25 


3-63 


2.40 


2.76 


100.40 


100.76 


99 


255-4 


224.7 


3-17 


3-50 


2.34 


2.68 


101.34 


101.68 


100 


261.9 


230.6 


3-09 


3-37 


2.29 


2.61 


102.29 


102.61 


loi 


268.3 


236.5 


3-00 


3-23 


2.23 


2-54 


103.23 


103.54 


102 


274.8 


242.4 


2.91 


3.08 


2.20 


2.49 


104.49 


104.49 


103 


281.3 


248.3 


2.81 


2.90 


2.07 


2-43 


105.07 


105.43 


104 


287.8 


254-2 


2.70 


2.69 


2.00 


2.38 


106.00 


106.38 


105 


294-3 


260.1 


2.62 


2-43 


2.00 


2-33 


107.00 


107.33 


106 


300.7 


266.0 


2.50 


2.11 


2.00 


2.16 


108.00 


108.16 


107 


307.2 


271.9 


2-33 


1.67 


2.00 


1.61 


109.00 


108.61 


108 


313-7 


514.6 


2.08 


1.09 


2.00 


•95 


110.00 


108 95 


109 


320.2 


757-3 


1-75 


•75 


1.67 


.67 


110.67 


109.67 


no 


326.7 


1 000.0 


1-37 


•50 


^■Zl 


•50 


111.33 


110.50 


111 


663-3 


- 


.90 




1.00 




112.00 


- 


112 


1 000.0 


~ 


-50 


— 


•50 


— 


112.50 


"" 



* Average Future Duration of Life, so-called " Expectation of Life.' 



OF EACH SEX IN MICHIGAN. 



9 



Table 2. — Exhibiting the essential parts of Life Tables, for each Sex, in the 
Healthy Districts of England, stating the Chances of Death for one thou- 
sand persons living at each age, the Average Future Duration of Life at 
every ffth age, the Probable Future Duration of Life at each age, and the 
Probable Ag;e at Death. 



As;e in 

Years. 


Deaths to 
sand 1 


one thou- 
ving.i 


Mean after Lifetime 
at each age.- 


True Expectation of 
Life (Probable Life).i 


Probable As 


e at Death.i 




Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 





1 1 2.8 


92.6 


48.56 


49-45 


58-55 


59-24 


58.55 


59.24 


I 


35-1 


31-9 




- 


62.32 


62.26 


63.32 


63.26 


2 


21.8 


21.7 


_ 


- 


62.41 


62.34 


64.41 


64.34 


3 


15.4 


15-3 


_ 


- 


62.04 


62.02 


65.04 


65.04 


4 


12.6 


12.5 


_ 


- 


61.46 


61.48 


65.46 


65.48 


5 


10.3 


10.3 


54-39 


53-93 


60.80 


60.84 


65.80 


65.84 


6 


8.3 


8.4 






60.06 


60.13 


66.06 


66.13 


7 


6.7 


7.0 


_ 


- 


59-24 


59-36 


66.24 


66.36 


8 


5-5 


5-9 


- 


- 


58.39 


58.55 


66.39 


66.55 


9 


4.6 


5-2 


- 


- 


57-51 


57.71 


66.51 


66.71 


10 


4.0 


4-7 


51.28 


50.88 


56.61 


56.84 


66.61 


66.84 


II 


3-6 


4-5 




- 


55.70 


55-97 


66.70 


66.97 


12 


3-6 


4-5 


- 


- 


54-78 


55.08 


66.78 


67.08 


13 


3-6 


4-7 


_ 


- 


53.86 


54.20 


66.86 


67.20 


14 


3-9 


5-1 


- 


- 


53.05 


53.32 


67.05 


67.32 


15 


4-3 


5-5 


47.20 


47.04 


52.13 


52.44 


67.13 


67.44 


16 


4-7 


6.0 




- 


51.23 


51.58 


67.23 


67.58 


17 


5-2 


6.5 


_ 


- 


50.34 


50.72 


67.34 


67.72 


18 


5-8 


6.9 


_ 


- 


49.46 


49.88 


67.46 


67.88 


19 


6.4 


7-4 


- 


- 


48.59 


49-05 


67.59 


68.05 


20 


7.0 


7-7 


4340 


43-50 


47-74 


48. 2 2 


67.74 


68.22 


21 


7-1 


7-9 






46.89 


47.40 


67.89 


68.40 


22 


7-3 


8.0 


- 


- 


46.05 


46.57 


68.05 


68.57 


23 


7-5 


8.1 


- 


- 


45.20 


45.76 


68.20 


68.76 


24 


7.6 


8-3 


- 


- 


44.36 


44.94 


68.36 


68.94 


25 


7.8 


8.4 


39-93 


40. 1 S 


43.52 


44.12 


68.52 


69.12 


26 


7.8 


8-5 




- 


42.68 


43.30 


68.68 


69.30 


27 


7-9 


8.6 


- 


- 


41.84 


42.48 


68.84 


69.48 


28 


8.0 


8.8 


_ 


- 


41.00 


41.66 


69.00 


69.66 


29 


8.1 


8.8 


_ 


- 


40.16 


40.84 


69.16 


69.84 


30 


8.2 


8.9 


36-45 


36-85 


39-31 


40.02 


69.31 


70.02 


31 


8.3 


9.0 






38-47 


39.20 


69.47 


70.20 


32 


8.3 


9.1 


- 


- 


37-63 


38.37 


69.63 


70.37 


Zl 


8.4 


9.2 


- 


- 


36.79 


37.55 


69.79 


70.55 


34 


8.5 


9-3 


- 


- 


35-94 


36.73 


69.94 


70.73 


35 


8.7 


9.4 


32.90 


33-46 


35.10 


35.90 


70.10 


70.90 


36 


8.8 


9-5 






34.25 


35.08 


70.25 


71.08 


37 


8.9 


9-7 


- 


- 


33-41 


34.25 


70.41 


71.25 


38 


9.0 


9.8 


- 


- 


32.57 


33.42 


70.57 


71.42 


39 


9.2 


9.9 


- 


- 


31.72 


32.59 


70.72 


71.59 


40 


9.6 


lO.O 


29.29 


30.00 


31.19 


31.77 


71.19 


71.77 


41 


9.6 


10.2 


- 


- 


30.04 


30.94 


71.04 


71.94 


42 


9.8 


10.3 


- 


- 


29.20 


30.11 


71.20 


72.11 


43 


10. 1 


10.5 


_ 


- 


28.36 


29.28 


71.36 


72.28 


44 


10.4 


10.7 


- 


- 


27.52 


28.45 


71.52 


72.45 


45 


10.8 


10.9 


25-65 


26.46 


26.69 


27.63 


71.69 


72.63 


46 


II. I 


II. I 




- 


25.86 


26.80 


71.86 


72.80 


47 


II. 5 


11.4 


- 


- 


25.03 


25.98 


72.03 


72.98 


48 


12.0 


11.6 


- 


- 


24.21 


25.15 


72.21 


73.15 


49 


12.5 


1 1.9 


- 


- 


23.39 


24-33 


72.39 


73.33 



1 Computed from Dr. Farr's Life Tables. 

2 Average Future Duration of Life, so-called " Expectation of Life." Taken from Dr. Farr's Life Tables 
for Healthy Districts. Quoted from Walford's Insurattce Cyclopisdia. 



10 REPORT ON THE DEATH-RATE 

Table 2. — For Healthy Districts of England, Cojitinued. 



Age in 


Deaths to one thou- | 


Mean after Lifetime 


True Expectation of 






Years. 


sand 1 


ving.^ 


at each age.^ 


Life (Probable Life).' 


Probable Ag 


e at Death.i 




Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


Males. 


Females. 


50 


13.0 


12.2 


22.03 


22.87 


22.58 


23-51 


72.58 


73.51 


51 


13-6 


12.5 


- 


- 


21.77 


22.69 


72.77 


73.69 


52 


14.2 


12.9 


- 


- 


20.96 


21.87 


72.96 


73.87 


53 


14.9 


^■3 


- 


- 


20.16 


21.06 


73.16 


74.06 


54 


157 


13-7 


- 


- 


19-37 


20.24 


73.37 


74.24 


55 


16.5 


14. 1 


18.45 


19.24 


18.59 


19-43 


73.59 


74.43 


56 


17.4 


14.2 


- 


- 


17.81 


18.63 


73.81 


74,63 


57 


18.3 


16.2 


- 


- 


17.04 


17.82 


74.04 


74,82 


5S 


19.4 


18.2 


- 


- 


16.28 


17.04 


74.28 


75.04 


59 


21.4 


20.3 


- 


- 


15-52 


16.27 


74.52 


75.27 


60 


237 


22.3 


15.06 


15-69 


14.79 


15-53 


74.79 


75,53 


61 


26.1 


24.4 


- 




14.07 


14.81 


75.07 


75.81 


62 


28.S 


26.5 


- 


- 


13-38 


14.10 


75.38 


76.10 


63 


3I-I 


28.8 


- 


- 


12.71 


13-42 


75.71 


76.42 


64 


33-9 


31.2 


- 


- 


12.06 


12.75 


76.06 


76,75 


65 


36.8 


33-9 


12.00 


12.5S 


11-43 


12.10 


76.43 


77.10 


66 


44.8 


36-7 


- 


- 


10.S2 


11.47 


76.82 


77.47 


67 


43-4 


39-7 


- 


- 


10.23 


10.85 


77.23 


77.85 


68 


47.2 


43-1 


- 


- 


9.66 


10.26 


77.66 


78.26 


69 


51.2 


46.8 


- 


- 


9.11 


9.68 


78.11 


78.68 


70 


55-6 


50.8 


9-37 


9-85 


8.58 


9.12 


78.58 


79.12 


71 


60.4 


55-2 




- 


8.07 


8.59 


79.07 


79.59 


72 


65-7 


60.0 


- 


- 


7-59 


8.08 


79.59 


80.08 


73 


71-3 


65.2 


- 


- 


7-13 


7.59 


80.13 


80.59 


74 


77-4 


71.0 


- 


- 


6.69 


7.12 


80.69 


81.12 


75 


84.0 


77-2 


7-15 


7-52 


6.27 


6.67 


81.27 


81.67 


76 


91. 1 


83-9 






5.87 


6.25 


81.87 


82,25 


77 


98.6 


91. 1 


- 


- 


5-50 


5.84 


82.50 


82.84 


78 


106.9 


99.0 


- 


- 


5-14 


5-47 


83.14 


83.47 


79 


115-5 


107.3 


- 


- 


4.81 


5.10 


83.81 


84.10 


80 


124.9 


1 16.2 


5-37 


5-64 


4.50 


4-77 


84,50 


84.77 


81 


1347 


125.8 


- 




4.20 


4.46 


85.20 


85,46 


82 


145.2 


135-9 


- 


- 


3-93 


4.16 


85.93 


86,16 


^3 


156.4 


146.9 


- 


- 


3-68 


3.88 


86.68 


86,88 


84 


167.9 


1 58. 1 


- 


- 


3-44 


3-63 


87.44 


87.63 


85 


180.2 


173.0 


4.01 


4.19 


3.21 


3-39 


88.21 


88,39 


86 


1934 


182.9 


- 




2.99 


3.16 


88.99 


89.16 


87 


206.5 


196.5 


- 


- 


2.81 


2-95 


89.81 


89.95 


88 


220.8 


210.0 


- 


- 


2.64 


2.77 


90.64 


90.77 


89 


235-6 


224.5 


- 


- 


2.48 


2-59 


91.48 


91.59 


90 


2507 


240.3 


2.99 


3-" 


2.32 


2.43 


92.32 


92.43 


91 


265.6 


254.8 


- 




2.17 


2.27 


93.17 


93.27 


92 


281.9 


272.1 


- 


- 


2.01 


2.12 


94.01 


94.12 


93 


301.2 


287.7 


- 


- 


1.90 


1.97 


94.90 


94.97 


94 


314-5 


307.7 


- 


- 


1.81 


1.86 


95.81 


95.86 


95 


335-1 


321.4 


2.25 


2.32 


1. 71 


1.76 


96.71 


96.76 


96 


348.8 


345-0 






1.63 


1.66 


97.63 


97.66 


97 


369.0 


357-1 


- 


- 


1.52 


1-59 


98.52 


98,59 


98 


396.2 


375-0 


- 


- 


1.42 


1.50 


99.42 


99,50 


99 


406.2 


400.0 


- 


- 


1.38 


1.41 


100.38 


100,41 


100 


421. 1 


407.4 


1.69 


1-75 


1.30 


1.36 


101.30 


101.36 


lOI 


454-5 


437-5 


- 




1. 17 


r-25 


102.17 


102.25 


102 


500.0 


444.4 


- 


- 


1.00 


1. 17 


103.00 


103.17 


103 


333-3 


600.0 


- 


- 


1.50 


•83 


104.50 


103.83 


104 


500.0 


500.0 


- 


- 


1. 00 


1. 00 


105.00 


105.00 


105 


1 000.0 


- 


- 


- 


•50 


1.50 


105.50 


106.50 


106 


~ 


1 000.0 


~ 


— 




•50 


— 


106.50 



1 Computed from Dr. Farr's Life Tables. 

* Average Future Duration of Life, so-called " Expectation of Life." Taken from Dr. Farr's Life Tables 
for Healthy Districts. Quoted from Walford's Insurance Cyclopcedia. 



OF EACH SEX IN MICHIGAN: 1 1 

After making the most that could conveniently be made of the evidence 
to be obtained in Michigan, it became desirable to bring external evidence 
to bear upon the result. In looking about for some proper standard of 
comparison, the Life Tables constructed by Dr. Farr for the "healthy dis- 
tricts" of England have been selected, for several reasons: the two locali- 
ties are not very dissimilar as regards average temperature, moisture of the 
atmosphere, etc. ; both are nearly surrounded by water, the inhabitants of 
the two localities number about the same, and although there are many 
points of contrast, these " healthy districts " of England bear quite a close 
relation to Michigan as regards conditions affecting life and health. 
Finally, it is about the only locality of which I have seen Life Tables which 
seem worthy of confidence as approximate statements. Life Tables of in- 
sured persons can be more easily secured ; but comparisons therewith 
cannot be undertaken here, however interesting they may prove to be. 

As regards the selection of these " Healthy Districts of England," Dr. 
Farr says : — 

" ^Ye have no means of ascertaining what the rate of mortality would be among men 
living in the most favorable sanitary conditions : otherwise observations for a term of years 
on a considerable number of such persons would supply a standard rate with which other 
rates could be compared. In the absence of such a standard, the districts of England in 
which the mortality rate did not exceed 17 annual deaths in 1,000 living have been selected 
as the basis of a new Life Table. 1 

" For the sake of convenience, these were called ' healthy districts,' consisting of sixty- 
four, or nearly a tenth part of the total registered districts of England and Wales, and in- 
habited by nearly a viillion of people. Sixty-three of these districts have been taken as the 
basis of the new Life Table." '^ 

It is not claimed that we have gained a knowledge of the rate of mor- 
tality among persons living under the most favorable sanitary conditions. 
On this point Dr. Simon, in the First Report to the Privy Council, said : 
" In conclusion, I beg to observe that even in the very districts to which, 
provisionally, I refer as standards of health, there are deaths of a prevent- 
able kind ; not many, indeed, but enough to satisfy your lordships that the 
healthiness of those districts, as compared with perfection, is but of moder- 
ate excellence ; and enough to show that, if in those districts the popula- 
tion had exhausted all known means for removing the causes of disease, 
their death-rate would have contrasted still more strikingly with that of the 
unhealthier districts." ^ 

The results of a comparison of the two Life Tables are best shown by 
means of diagrams. Diagram No. i exhibits, by numbers down from the 
top, and stated at left side, the deaths in 1,000 persons of each sex, at each 
age, in Michigan, and in the " healthy districts " of England. It will be seen 
that the several lines representing these four classes of persons bear a very 

1 William Farr, M. D., F. R. S., Annual Report of Registrar General, 1859, p. 174. 
Walford's Insuranee Cyclopcedia, vol. ii., p. 538. 

'^ Dr. Farr, Philosophical Transactions for i860; Assurance Magazine, vol. ix., p. 121 ; 
Walford's Insurance CyclopcEdia, vol. ii., p. 539. 

3 Dr. Simon, in First Report to the Prizy Coicncil, 1S59 ; Walford's Cyclopcedia of Insur- 
ance, p. 540. 



12 



REPORT ON THE DEATH-RATE 



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OF EACH SEX IN MICHIGAN. 13 

close resemblance at all ages until that of eighty years is reached, when 
the lines for England fall below those for Michigan, indicating, according 
to the data used, a higher death-rate at the older ages in England than in 
Michigan. The slightly greater death-rate in Michigan of those under one 
year of age may be explained by the fact that in Michigan still-births are 
included, but this will not explain the slightly greater death-rate at other 
ages under five years. 

Diagram No. 2 exhibits graphically the probable duration of life of 
males in Michigan ; and, by means of lines marking the upper limit of the 
probable life of females in Michigan and of males in the " healthy districts " 
of England, the close correspondence therewith is rendered apparent. At 
the top of the diagram is also exhibited the limit of " Possible Life." The 
heavy straight line at the top of the diagram is the limit of possible life of 
males in Michigan, — at the age of 112 years. The dotted straight line 
near the top of the diagram is the limit of possible life of females in Mich- 
igan, — no years. The dashed straight line near the top of the diagram 
is the limit of the possible life of males in the " healthy districts " of England, 
— 105 years. A corresponding line showing the limit of possible life for 
females is not drawn, as it would fall so near the line for males as not to be 
noticeable, — 106 years. The heavy vertical lines represent the probable 
life of males in Michigan. The bottoms of these lines begin at each 
succeeding age, from birth to 112 years. The tops of the lines are opposite 
the probable age at death, shown in the column on the left. As the dia- 
gram is drawn to scale, the probable duration of life is shown for each age 
by the length of the heavy vertical line. The dotted line, running near 
the tops of the vertical lines, represents the limit of probable life for 
females in Michigan, and the line of dashes shows the limit of probable 
life of males in the " healthy districts " of England. The corresponding line 
for females runs so near to this that it cannot well be drawn. The starting- 
point for each sex in each country is the same as for the males in Michigan; 
namel}^, opposite each particular year of age, shown on the left of the dia- 
gram for every decennial year. 

One of the objects in view in preparing Diagram No. 2 was to enable 
those who examine it most easily to appreciate the very great difference 
between the "Probable Life" and the "Possible Life" at each and every 
age. This diagram relates to the " Healthy Districts " of England and to 
the healthful State of Michigan, and it will be seen by the line referring to 
Michigan, in this diagram, that except for the ages between one and 
twenty-five years, man does not live out one half of his " possible " time ; 
and of the males in England only those aged under thirty-six years live out 
one half their " possible time." The total death-rate appears to be about 
the same in the two localities. The difference in this statement in the 
ages, — twenty-five in Michigan and thirty-six years in England, is caused 
by the shorter possible time in England, the time of which is stated as 105, 
whereas in Michigan it is believed to be not less than 112 years. 



H 



REPORT ON THE DEATH-RATE OF MICHIGAN. 





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INFANT MORTALITY IN MICHIGAN. 1 5 



INFANT MORTALITY IN THE STATE OF MICHIGAN. 

BY H. B. BAKER, M. D. 

Secretary State Board of Health a7id Superintendent of Vital Statistics of Michigan. 

READ AT THE ANNUAL MEETING IN BALTIMORE, NOVEMBER II, 1875. 

These statements are worked out from my " Life Tables " for this State, 
and are believed to be as near the truth as it is practicable to attain at 
this time.'^ Quite different statements would appear if there were an attempt 
to make them from the per cent, of deaths under five to deaths at all ages. 
Perhaps this might properly be done if the population of the State was a 
" fixed " population, such as would be maintained by the birth-rate, and con- 
trolled by the death-rate which prevails in this State, but the actual popula- 
tion differs from such a " fixed population " by containing a larger propor- 
tion of children under five years of age. In such a "fixed population," as 
computed from my Life Tables for this State, the proportion of persons liv- 
ing aged under five years, to the total number at all ages, is as follows : 
males, 9.30 ; females, 9.56 per cent. By the census of 1874, it appears that 
in the actual population the proportion is as follows : males, 13.24; females, 
14.05 per cent. The per cent, of deaths under five to total deaths is con- 
sequently larger than it would be if the population was fixed at that which 
would be controlled by the death-rate in this State, without modification by 
immigration or emigration. For the year 1872 the per cent, of deaths of 
those under one year of age to the total deaths was : males, 25.42 ; females, 
23.17; of deaths of those aged under five years to total deaths it was: 
males, 42.44 ; females, 40.30. 

" What causes are contributing most to infant mortality ? (7) " — So far as re- 
lates to causes specified in the returns, they are in the order named. Scarlet 
Fever, Diarrhoea, Cholera Infantum, Pneumonia, and Dysentery. For the 
year 1873, the deaths reported from these diseases, of those aged under five 
years, were for each disease in the order named above: 361, 326, 302, 258, 
and 252. If the deaths from Diarrhcea, Cholera Infantum, and Dysentery 
be grouped together, and the deaths from " Bowel Diseases " be added, the 
aggregate number is indeed large. There is not much difficulty in fixing the 
actual cause of the excessive mortality from these specified causes among 
the conditions connected with the hot season of the year. It is also reason- 
ably certain that the mortality from these causes is greater in cities and vil- 
lages than in rural districts. I have no hesitation in subscribing to the be- 
lief that much of this infant mortality could be prevented by thorough and 

1 The questions to which tlie writer here attempts to reply were submitted to him by 
the Secretary of the Public Health Association in the following terms : — 

" Infant Mortality. — What percentage of all infants born alive in your community sur- 
vive to their first birth-day.?" {Ans. — I reply that for this State, including still-births, 
it is : males, 83.09 per cent. ; females, S6.50 per cent. Concerning those born alive, I have 
made no special computation.) 

" What per cent, survive to the fifth .? " {Ans. — Including still-births, 73.32 per cent, of 
the males, and 77.70 per cent, of the females born survive to their fifth birth-day.) 



1 6 INFANT MORTALITY IN MICHIGAN. 

enlightened action by local boards of health in cities and villages. Much 
more might be prevented if the parents, in all parts of the State, were well 
informed as to the causes of infant mortality. To collect and disseminate 
information on such subjects is the function of the State Board of Health. 
For this work " Vital Statistics " are essential ; and although the system of 
registration and report of vital statistics is somewhat new in this State, much 
information of great value has already been collected upon this subject ; and 
it is hoped that the time is not far distant when the State Board of Health, 
already established in this State, can disseminate among the people such in- 
formation on this subject as will tend to lessen the infant mortality in pro- 
portion as its warnings are heeded by the people. 

Inflammation of the lungs is one of the prominent causes of infant mortality 
in this State. As to the actual cause of this disease, if the evidence already 
collected in the vital statistics of this State shall be verified by further ex- 
amination, much of the infant mortality from this cause may be prevented 
by intelligent action of those who may control the condition of the air in 
dwellings and schools, as regards purity and humidity, but more especially 
as regards the warmth and humidity of the atmosphere in the sleeping-rooms 
of the children. The greatest number of deaths from this disease seems to 
occur in a cold and dry atmosphere. 

In my first reply to the question " (7)," the deaths from scarlet fever 
were stated for the year 1873. From this disease, deaths had previously 
been reported of those aged under five years as follows : in 1869, 163 
deaths: in 1870, 531 deaths; in 1871,408 deaths; in 1872,336 deaths. 
It will be seen that this is one of the important causes of infant mortality 
in this State. In my opinion a very considerable proportion of the deaths 
from this cause might be prevented, and will be prevented, as soon as the 
people will act upon the instructions of the State Board of Health. It will 
take some time, however, for this influence to permeate the whole people 
sufficiently to result in uniform, prompt, and efficient action for the accom- 
plishment of this result. My belief in the preventability of much of the 
mortality from scarlet fever is based in part upon the belief that the disease 
is less fatal among persons who have passed the age of five or six years. 
Unfortunately we have not yet such records of cases of the disease in this 
State as will enable one to verify or disprove this belief. If it is true, then 
prompt isolation of first cases, and thorough destruction of the contagium, 
will result in saving the lives of many, by postponing the time when the dis- 
ease shall be contracted. But whether the mortality is or is not less after 
the infantile period, many lives may be saved by the means suggested ; for 
to some thus shielded in infancy the contagium may never again come in 
sufficient force to cause the disease. It seems probable that, even with no 
systematic effort for that purpose, many persons now pass through life with- 
out ever having the disease. It is the solemn duty of local boards of health 
to largely increase this number. I regard the great slaughter of the inno- 
cents in this State, by this disease, as a stinging reproach to the local boards 
of health for their inefficiency, and a powerful argument for the need of a 
State Board of Health, charged with the noble duty of educating the people 
in the way of life. 



LIBRARY OF CONGRESS 



013 738 844 3 



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